Depression during pregnancy has been brought into the limelight thanks to a lengthy article in Maclean’s magazine entitled “The Controversy surrounding antidepressants and pregnancy.” Today we will break down the article to summarize research and insights into a specific class of antidepressant drugs used by pregnant women called selective serotonin reuptake inhibitors (SSRI). We will also look at depression in pregnancy: what it is, associated risks, and treatment and support options.Summary of Maclean’s Controversy Surrounding Antidepressants and PregnancyAlthough there are several types of SSRI’s used to treat depression in pregnant women, this article focuses on the SSRI known as Paxil (generic name paroxetine).Paxil use in pregnant women has made headlines for years, but has recently been in the news because of a precedent-setting class action lawsuit in Canada against the makers of Paxil for causing birth defects.A brief timeline of Paxil use in pregnancy is as follows:

1992: Paroxetine was first marketed by maker GlaxoSmithKline (GSK)

1993-2009: Almost six million Paxil prescriptions were written to Canadian women of child-bearing age

2006: Journal of the American Medical Association (JAMA) study found that women who stopped taking SSRIs when pregnant were far more likely to relapse into depression (it was later revealed all of the 13 authors had failed to disclose drug-company funding of research)

2007: Meta-anaylsis indicates an increase in heart defects in children born to women who used paroxetine. They also note that detection bias cannot be ruled out (i.e. – women who take Paxil have more ultrasounds so they are more likely to detect a heart defect in their unborn children). The corresponding author and head of Motherisk, Dr. Gideon Koren, went on to produce further papers stating that Paxil does not increase the rate of heart defects at birth, especially when taken in second and third trimesters and that many cardiac defects detected in early pregnancy correct themselves before birth

2009: Non-systematic review asserts the association of paroxetine and cardiovascular heart defects is still not proven and urges for more research (this review was funded in part by GSK)

Currently: More than 2,500 lawsuits linking birth defects to use of SSRIs have been launched in the U.S. and Canada has launched a class-action lawsuit against GSK for the association of Paxil and heart-related birth defects

If this timeline seems a little confusing, that’s because it is! There are a myriad of studies on Paxil use in pregnancy, and some of these show conflicting results. To further complicate matters, research funding from pharmaceutical companies such as Paxil-maker GSK can possibly lead to biased results as mentioned in the timeline.One thing that most can agree on is that more high-quality research is needed on the topic of antidepressants and pregnancy. Unfortunately there is a lack of randomized controlled trials involving Paxil use in pregnant women. Randomized controlled trials (RCT’s) are considered the most informative types of studies, as they directly compare a random group of women taking a medication against a similar random group of women who are not taking the medication. It is rare to find an RCT involving medications and pregnant women because there are too many ethical issues involved when offering a pregnant woman a medication that can have potential negative effects on her developing fetus. Therefore we have to rely on other forms of research to make decisions about the safety of medication use in pregnancy.Although there is research to suggest Paxil use in pregnancy can increase the risk of negative outcomes, it is not simply a black and white case. Based on research available, the likelihood of a heart defect in a baby born to a mother who has taken Paxil rises from 1% to 2%. Although this risk is double the normal population, it is still a rare occurrence. There is also evidence to suggest women with severe depression that stop taking their medication increase their risk of negative outcomes on mother and baby. The risks and benefits of Paxil use need to be balanced with the risks and benefits of stopping antidepressant medication. This should be analyzed on a case-by-case basis in consultation with a mental health professional to determine the best course of action for mother and child. A pregnant woman should not stop taking antidepressant medication without speaking to her healthcare providers first.Depression in Pregnancy: The FactsIt can be difficult to properly diagnose depression in pregnancy because many of the symptoms of depression can be caused by other pregnancy-related changes. The best way to determine if someone is experiencing depression is to seek help from a team of health care providers, specifically the physician monitoring care during pregnancy and a mental health professional. Shockingly, according to the Maclean’s article, less than one third of people on antidepressants have been seen by a mental health specialist for a clinical diagnosis. A mental health professional is the person most qualified to properly assess your specific case and should be consulted whenever possible.Risks Associated with Untreated DepressionThose experiencing symptoms of depression are encouraged to seek treatment as soon as possible to reduce the risks of untreated depression in pregnancy. Risks may include:It is important to remember that not all women with depression will experience the items in the above list. It does mean that pregnant women with depression will have a higher risk of experiencing them compared to pregnant women without symptoms of depression.Treatment Options for Depression in PregnancyThere are a number of treatment options for those experiencing symptoms of depression. The type of treatment offered will depend on the severity of the symptoms. Milder forms are often treated with nutrition and exercise changes, individual or group counseling, peer support groups, and/or light therapy. More severe cases may also require an antidepressant, a type of medication that reduces the symptoms of depression. There are two types of antidepressant medication prescribed to pregnant mothers: selective serotonin reuptake inhibitors (SSRI) and Tricyclic antidepressants (TCA).SSRI drugs include:

Prozac (fluoxetine)

Lexapro (escitalopram)

Zoloft (sertraline)

Celexa (citalopram)

Effexor (venlafaxine)

Paxil (paroxetine)

TCA drugs include:

Elavil (amitriptyline)

Tofranil (imipramine)

Pamelor (Aventyl, nortriptyline)

Ideally, a pregnant woman will work with her physician and a mental health specialist to determine a treatment plan. If a woman is on antidepressants before she gets pregnant, it is important to talk with her health care team about a plan to continue or change treatment to reduce the risk of negative outcomes.Online Resources and SupportOnline, telephone, and local support groups for mothers and their families experiencing depression before or after the birth of their child can be found at:Postpartum Support InternationalFamilies MatterThe Online PPD Support GroupPostpartum DadsHigh quality websites that house information on depression before and after the birth of a child include:March of DimesCaring for KidsPublic Health Agency of Canada

Depression in pregnancy days is as harmful as poison for living body. Yes, you are not alone in these days but one more life is depending upon you. If you got depressed then it will not only bad for your health but for your baby. So physician recommend different tips for kicking out depression. If you have some kinds of depression as well as pregnant then massage can help you to relief over the depression and feel calm. Anyway here are some great tips discussed which are very helpful to control depression.

Drugs are not recommended during the pregnancy but if the mothers health is in the risk drugs must be taken. Women who use antidepressant during pregnancy must take information from their doctor about their therapy. Yoga can help you in fight with depression.